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What one thing do you think would make healthcare work in America?

Single payer — but we pay premiums
Free to everyone — paid from taxes
Insurance for catastrophe only — everything else out of pocket
Something else — what might it be?

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1. Patricia Pomerleau CEOExpressSelect Member
     Forum Moderator
     (6/21/2017 10:05:37 PM)
     Message ID #286233

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Hillary Clinton couldn't do it when her husband was president. Intervening administrations couldn't do it. Finally, President Obama pushed a health care system so complex that Rep. Nancy Pelosi famously explained, “... we have to pass the [health care] bill so that you can find out what’s in it....” And, of course, President Trump campaigned on and won an election, at least partially, because he wants to repeal Obamacare and start over.

With so many failures and controversy, we have to ask: Are we, as a nation, going about health care the wrong way? Why do we have dozens of insurance companies negotiating rates and setting rules for patient care? If a hospital and physician set high prices for services but are willing to negotiate down and write off the difference, what's up with that? Doesn't that cost a lot of overhead for nothing?

What would happen if the insurance companies weren't in the middle of the intersection among patients, physicians, hospitals, and pharmacies? Would we get better care if so many dollars didn't go to administrative costs?

We think any administration could make a case for making Medicare the nation's single payer. Healthcare insurance for everyone via a premium system that would be affordable.

It's important to understand the terms so we're on the same page. With some help from our friends at Wikipedia:

Single-payer healthcare is a system in which all residents pay the state – via taxes in amounts determined by the state – to cover core healthcare costs for all residents regardless of income, occupation, or health status – rather than select individuals buying from private insurers with varying health care coverage dependent upon their specific needs and ability to pay. Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).

The term 'single-payer' thus describes the funding mechanism, referring to healthcare financed by a single public body from a single fund, not the type of delivery or for whom physicians work.

The actual funding of a 'single-payer' system comes from all or a portion of the covered population via taxes. In contrast multipayer healthcare uses a mixed public-private system.
Is healthcare a human right?
  • The cost of being sick or injured goes way beyond the individual. Do you enjoy being around sick people who are working because they don't have a choice?

  • Medicare is a government success story. It works for those over 65 (and with earlier entry for cause). Why not Medicare for all, especially our children?

  • A criticism of Great Britain's National Health Service is rationing. It can be hard to get some services in a timely fashion. How would you address that?

  • No system is going to be perfect or able to solve all of America's healthcare needs. But can we do better than what we have?

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Message edited by user at 6/21/2017 10:08:05 PM

2. Robert Fahrbach CEOExpressSelect Member
     (6/22/2017 4:43:49 AM)
     Message ID #286234

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A single payer system would not effect the quality of healthcare in America. Only the education system can do that. It would, by virtue of economies of scale, elimination of redundancies, and effective oversight - make it far less costly - and make it possible to provide a consistent level of care for all citizens. There is no valid argument against a single payer system if coverage for all is the goal.

There are, however, hundreds of assumptions in that statement- many of which simply don't apply in America at this time.

The most basic of these is whether or not the people of a nation want to provide healthcare for all. It isn't a 'right' (whatever that is)... it is a choice that a free people can adopt or decline.

Partnering with fellow citizens to provide such a complex service requires a citizenry that wants such a partnership. Speaking for myself - I no longer do. I don't have enough in common with many Americans to trust or partner with them. It doesn't matter why.

But I am only one person. I cannot make or break the American pact - or its implications (of which national healthcare is one). I can, however say No... I am not in favor of extending my commitment to a failed pact. Under the current environment - in which subsets of the citizenry are trying to wrestle control of the nation by force - rather than by the terms of the existing pact - my commitment is to decline all benefits until my presumed 'partners' are ready to honor that pact as it is - not as they want it to be.

I support NO social services at this time and find it CRAZY that it should even be on the table - and past crazy that some people see it as a right.

I urge Congress to repeal Obamacare and do nothing else. I trust the free market system to do a better job.

Message edited by user at 6/22/2017 4:55:32 AM

3. Thomas C CEOExpressSelect Member
     (6/22/2017 6:39:34 AM)
     Message ID #286235

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In 1952 United Steelworkers went on strike against US Steel and 9 other companies, it was a dire situation. Truman issued an EO to nationalize all the steel companies, but it was quickly struck down by the SC as unconstitutional. The strike only lasted 4 months, but as part of that settlement, Congress allowed employer paid healthcare premiums to be excluded from workers' earned income. At the time it was nominal, as BC/BS was a Doctors' co-op and had only been in existence for a dozen years.

About '60 NYC allowed it's school teachers to unionize, Kennedy followed suit with Federal workers, and these bargaining units negotiated better and better healthcare plans. All income tax free.

With Medicare in '65 the cost skyrocketed with thousands of new patients. By '72 Nixon proposed a plan to mandate employer groups, and phase out the ESI exclusion, which by that time had taken many buying decisions out of the consumers hands. Later, Reagan made another very feeble attempt to also phase it out. At the same time, the Federal Tax code allows out of pocket medical deduction, but since it was amounts greater than 7% of gross, it became the last dollar spent on medical care, not the first.

In the early '80's Insurance companies added scripts as a benefit to remain competitive, medical imaging came into the marketplace and the costs exploded. By '93 HRC along with Ira Magaziner attempted to tackle the problem. Part of their solution was again phasing out the ESI exclusion. The premiums were becoming a large part of workers pay package.

Then the government gave us section 125, "cafeteria plans" which took the employee portion of the premiums out of their gross pay when calculating FICA. That created a huge disparity in the individual market that remains today, pretax dollars vs. after tax dollars buying premiums. It was also about that time that insurance companies introduced "cost sharing" to employer groups. The unions negotiated for better enhanced plans that were all inclusive, no deductibles.

Jonathan Gruber in a lecture at Holy Cross in '09 explained to a group of medical professionals that Obamacare would need to be a three legged stool, individual mandate, employer mandate, and phasing out the ESI Exclusion. At that time he explained the tax exclusion was almost $600 billion lost tax revenue, which was a sum that could pay all of Medicaid. Zeke Emmanuel and Obama said absolutely no, it's political suicide and we'll all lose our jobs. As a compromise they came up with an excise tax on the insurance companies themselves for "Cadillac Plans", but it was never phased in due to pressure on the WH by the Unions.

Today healthcare is like walking into Wal-Mart with someone else's debit card, there are some, but not enough market choices based upon price. A large part of the overall costs are pharmaceuticals that did not exist 25-30 years ago. Big Pharm has become a marketing machine. And very costly expensive negative testing that has become routine. There is very little direct patient pay, so predatory pricing plans are prevalent with providers.

Single payer failed in two states, VT and CO, it is now passed the first hurdle in CA, but the price tag will exceed the entire state budget.

4. Thomas C CEOExpressSelect Member
     (6/22/2017 6:39:55 AM)
     Message ID #286236

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In this country, nationalizing providers, or insurance companies will never be tolerated. So our "single" payer would be a hybrid with no cost controls at all. Medicare is the best example, and with about 50 Million insured we cannot afford to pay for it.

At least today, folks with a $1,500 to $2,500 deductible can say, no Doc I'll skip the MRI, it's only a twisted ankle. Obamacare jacked the deductible up to 10% of gross, it should be much lower so that folks are encouraged to negotiate for high deductible plans, and folks on the exchanges get a tax break.

One way or the other we must pay for those who cannot afford insurance. High income folks are getting away with not paying income tax on a $15k to $30k employer paid benefit. That is wrong.

5. Douglas Robb CEOExpressSelect Member
     (6/22/2017 7:57:23 AM)
     Message ID #286237

This message is in response to Patricia Pomerleau ( message id #286233 )  View All Related Messages

Well, we have finally revealed the true, dark, ugly underbelly of the health care argument and it has nothing to do with economics. Singlepayer works because it has worked well and is working well in Europe. It not only produces better results (by any metric you choose to measure it by), it does so at much lower cost per patient – one half to one third the cost per year per patient.
Why haven’t we implemented it then? We haven’t implemented it because the dark ugly racist, underbelly of America would rather cut off their nose to spite their face than have “those people” be benefitted. Most recently this was exhibited by those states that choose not to expand Medicaid.
It’s sad that immigrants can still come to America and be successful through their personal motivation and hard work, and that makes some of the unsuccessful, native born, white Americans jealous and angry because they think that they ‘deserve’ to be successful and they are not.
France’s singlepayer is very similar to our Medicare. Everybody gets an insurance card. Those that can afford it then buy a supplemental insurance plan to cover some of the costs. Those that can’t afford it get all their medical expenses paid. The big difference is that when you go to the doctor you pay the doctor upfront and get reimbursed by your supplemental. This greatly reduces fraud.
Three groups of Americans would be hurt if singlepayer was implemented in the United States: specialist doctors (surgeons, etc.), pharmaceutical companies, and insurance companies. Singlepayer controls costs by setting the cost.

Message edited by user at 6/22/2017 8:00:33 AM

6. D James
     (6/22/2017 8:41:58 AM)
     Message ID #286238

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Get government out of paying. Healthcare is good. It's the argument over method of payment, not the delivery. The indigent should be treated respectfully and humanely either by Medicaid grant, use of publicly paid for hospitals like Cook County in Chicago, and charity clinics such as one I volunteer for here in my town. t thought that was the issue - take care of those who are in tough straits until they get on their feet. Otherwise, people should have the ability to pay for routine services out of pocket like any other good or deliverable , and buy insurance akin to various products that are on the market to suit their needs. These products should be everything from a low cost high deductible catastrophic only policy all the way to a full kahuna provide for everything but pay the policy up - charges. Open the health insurance market across interstate boundaries with more competition and appropriate Federal regulatory oversight to address the interstate aspect, enact tort reform, and don't use the axiom that describes overreach of government in the creation of Obamacare and virtually everything else it lays its corrupt mitts, i.e., "If it ain't broke, fix it until it is".

Those that want "single pay" should go where that's the standard. Canada sounds good. So does Aussie land. And that Brit National Health is the bomb. Love the dental care, eh? Those that want "free" need to get an education and their minds out of the communist world of equally low standards and expectations. My idea is self-responsibility which leads to the individual taking on their own version of "single pay".

7. Robert Fahrbach CEOExpressSelect Member
     (6/22/2017 8:43:20 AM)
     Message ID #286239

This message is in response to Douglas Robb ( message id #286237 )  View All Related Messages

If by 'those people', you mean 'people who can't afford health care', I totally agree.

Government to me is a business deal...period.

If it makes sense to pay more to cover someone else - I am for it... but it damn well better have a quid pro quo. I have no interest, whatsoever, in struggling to meet someone else's bills.

You may try to spin that into some slick propaganda designed to induce peope to join the liberal con game with a silly guilt trip... but to me, you are nothing but another robo call.

8. D James
     (6/22/2017 8:50:34 AM)
     Message ID #286240

This message is in response to Thomas C ( message id #286235 )  View All Related Messages

Great post. I think the idea of employer provided health benefits to include doctor and hospital visits, plus eyeglasses, hearing aids and the usual, began right after WW2 when wage and price controls were still in effect and prospective employers could not compete on wages but could be creative with added on bennies. That also gave motion to things like corporate profit sharing plans akin to the one Sear put together as an enviable standard that made for comfortable retirements for their career employees. It is remarkable what the entrepreneur spirit can do to surmount what government would try, sometimes unwittingly and sometimes with malice (see Obamacare) to destroy.

9. Thomas C CEOExpressSelect Member
     (6/22/2017 9:00:55 AM)
     Message ID #286241

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Here is my Bill, I'll call it the Thomas-Robb Bill, aka T-Robbcare.

Set the itemized medical deduction as follows: 0% up to $75k of gross, 2% up to $150k, 5% above $150.

Eliminate the earned income ceiling on FICA.

Phase out ESI Exclusion over three years, starting at $300k. $200k, $100k, stop at $75k gross, keep it intact.

Index the $75k to CPI once per year.

Eliminate the individual and employer mandate, as well as the mandate on Guaranteed Benefit plans.

Keep the Ocare Taxes. Fully Fund PP, except abortions.

Allow Insurance Companies to cross state lines and allow non-employer groups to form such as AAA, Trade Associations, Chamber of Commerce, etc. Allow these groups to become self-insured, managed by an Insurance Company. Competitive bidding will drive down premiums.

Phase out individual plans, Group Only after 3 years, (we need to keep the Insurance Companies happy)

Allow the States complete management Medicaid, fully funded by the Federal dollars.

I need Doctor Robb as a co-sponsor, as I need a persistent obnoxious spokes person to get Schumer & Company on board.

Call it a day, kiss the baby goodnight!

10. D Robb
     (6/22/2017 9:01:51 AM)
     Message ID #286242

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Put aside idealology. Single payer provides better health care at much less cost. Simple. What is there not to like except it's a change
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